Hemorrhage complications in obstetric antiphospholipid syndrome: Risk factors and association with adverse pregnancy outcomes

Yongjing Luo; Jiayang Jin; Yani Yan; Mengyao Zhang; Lei Hou; Yuke Hou; Qiuyan Pei; Chun Li

doi:10.3389/fimmu.2023.1145146

Hemorrhage complications in obstetric antiphospholipid syndrome: Risk factors and association with adverse pregnancy outcomes

Front Immunol. 2023 Mar 17:14:1145146. doi: 10.3389/fimmu.2023.1145146. eCollection 2023.

Authors

Yongjing Luo¹, Jiayang Jin^{1

2}, Yani Yan³, Mengyao Zhang^{1

2}, Lei Hou⁴, Yuke Hou^{1

2}, Qiuyan Pei³, Chun Li^{1

2}

Affiliations

¹ Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.
² Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
³ Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China.
⁴ Department of Rheumatology and Immunology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.

Abstract

Background: Bleeding complications are recognized as relatively infrequent manifestations of antiphospholipid syndrome (APS), and the safety of antithrombotic therapy during pregnancy is of concern. This study aims to assess the risk factors and possible associations between bleeding complications and adverse pregnancy outcomes (APOs) in patients with APS.

Methods: A retrospective cohort study was conducted at the Peking University People's Hospital. The clinical and immunologic features, bleeding complications, treatment, and pregnancy outcomes of patients with APS were collected. Univariate and multivariate logistic regression analyses were applied to assess the associations between APOs and bleeding complications.

Results: A total of 176 participants with obstetric APS were included in the analysis. There were 66 (37.50%) patients with APS with hemorrhage complications and 86 (48.86%) patients with APS with APOs. Mucocutaneous hemorrhage was associated with APOs including fetal death after 12 weeks [odds ratio (OR) = 10.73, 95% confidence interval (CI): 1.61-71.74, p = 0.014], preterm delivery prior to 34 weeks (OR = 8.30, 95% CI: 2.31-29.84, p = 0.001), and small for gestational age (OR = 4.17, 95% CI: 1.22-14.21, p = 0.023) in univariate logistic regression analyses. It also independently associated with preterm delivery prior to 34 weeks (OR = 40.29, 95% CI: 1.45-1121.32, p = 0.030) in multivariate logistic regression analyses. Receiver operating characteristic (ROC) analysis evaluating the accuracy of these factors for preterm delivery prior to 34 weeks showed that the area under ROC curve was 0.871.

Conclusion: The study shows that mucocutaneous hemorrhage may be an indication of the occurrence of APOs in obstetric patients with APS.

Keywords: adverse pregnancy outcomes; antiphospholipid syndrome; hemorrhage complications; mucocutaneous hemorrhage; preterm delivery prior to 34 weeks.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antiphospholipid Syndrome* / complications
Antiphospholipid Syndrome* / therapy
Female
Hemorrhage / complications
Humans
Infant, Newborn
Pregnancy
Pregnancy Outcome
Premature Birth*
Retrospective Studies
Risk Factors

Grants and funding

This work was supported in part by the China International Medical Foundation (No. Z-2018-40-2101), the National Natural Science Foundation of China (Nos. 81871281 and 32200734), and Peking University People’s Hospital Scientific Research Development Funds (RDY2021-03 and RDY2021-10).